Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England

• Published in: BMJ open Vol. 10; no. 2; p. e033186
• Main Authors: Munford, Luke Aaron, Wilding, Anna, Bower, Peter, Sutton, Matt
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 06.02.2020; BMJ Publishing Group
• Subjects: Aged; Aged, 80 and over; Chronic Pain - economics; Chronic Pain - epidemiology; Cohort analysis; Cohort Studies; Community; Community Participation - economics; Community Participation - statistics & numerical data; Comorbidity; Costs; England; Female; Humans; Longitudinal Studies; Male; Older people; Participation; Patients; Primary care; Prospective Studies; Public Health; Quality of life; Quality of Life - psychology; Quality-Adjusted Life Years; Questionnaires; England; United Kingdom > UK; multimorbidity; administrative health care costs; community assets; social prescribing; societal net-benefit; long-term conditions
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-033186

ObjectivesImproving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. We use longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care.DesignProspective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation.SettingParticipation in community asset facilities. Costs of primary and secondary care.Participants4377 older people with long-term conditions.InterventionParticipation in community assets.Primary and secondary outcome measuresQuality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits.ResultsStarting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £−96 (95% CI £−512 to £321) at 6 months; £−283 (95% CI £−926 to £359) at 12 months; and £−453 (95% CI £−1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of −0.102 (95% CI −0.173 to −0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months.ConclusionsParticipation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.